Active Shooter Limitations – The Case for a Unified Tactical-Medical Response: The Critical First Five Minutes and Medical Rescue Team Delays
Introduction: The Clock Starts Before You Arrive
Every second in an active shooter event is a matter of life or death. The FBI reports that 93% of active shooter incidents are over within five minutes—often before the third police unit arrives, long before fire and EMS are given access, and well before medical treatment begins at the point of injury.
These five minutes—what we call the Golden Five—are not just critical for threat containment. They are decisive for trauma survival. Victims with survivable wounds are dying because medical intervention is delayed by legacy procedures and cultural hesitation.
The traditional paradigm of “scene safe, then treat” is not just outdated—it’s deadly. If we continue to treat medical response as secondary to tactical operations, we will continue to lose lives we could have saved. It’s time for a unified tactical-medical response—a model that deploys Medical Rescue Teams (MRTs) alongside law enforcement in the earliest stages of the incident, within Hot and Warm Zones, when their impact is greatest.
The Problem: Response Fragmentation and Cultural Paralysis
Despite decades of active shooter evolution, EMS and fire agencies are still routinely staged outside the crisis, waiting for law enforcement to clear the scene. Medical providers often don’t enter until 30–40 minutes after the shooting has stopped. By then, the damage is done. Bleeding has gone unchecked. Airway obstructions have become fatal. Survivable injuries have become fatalities.
The problem isn’t just protocol—it’s mindset. Law enforcement is trained to “go in,” while EMS is trained to “stay back.” These conflicting doctrines are deeply ingrained and reinforced through decades of isolated training and stovepiped policies. Command hesitates to risk medics, medics hesitate to move without law enforcement security, and leadership struggles to balance liability with necessity.
The result? Medical delay by design.
The Golden Five Minutes: Why MRTs Must Deploy Early
The Golden Hour has long been a trauma standard—but in active shooter scenarios, we must now focus on the Golden Five Minutes.
Within the first five minutes:
Victims suffer catastrophic hemorrhage
Casualties begin hypovolemic shock
Survivors self-evacuate, often untreated
Police may still be moving to contact
EMS is almost always staged
By minute six, the shooter may be dead. But so are some of the victims—not from gunfire, but from the absence of medical intervention.
This is where MRTs matter. MRTs, staged at the Tactical Command Post (TCP), trained to operate under force protection, and empowered to move with or immediately behind law enforcement, can deliver Warm Zone care and even Hot Zone triage under cover. Their presence shortens the time between injury and treatment, dramatically increasing survivability.
MRTs: The Link Between Tactics and Treatment
Medical Rescue Teams are not traditional ambulance crews. They are integrated, mission-capable units trained in both trauma medicine and movement through dynamic environments. Their mission is simple: bring trauma care to the casualty, not wait for the casualty to be brought to them.
An effective MRT must be:
Trained in TECC and rapid MARCH assessments
Equipped with gear for massive hemorrhage, airway, and chest trauma
Familiar with tactical movement, cover, and communication
Staged forward, not in a parking lot two blocks away
Command-aligned with both police and fire
MRTs act as a bridge between tactics and treatment. They are the answer to the operational gap between the first gunshots and the arrival of traditional EMS.
Warm Zone Operations: Understanding the Risk–Reward Equation
Critics of MRT deployment often cite risk. Entering a “not-yet-secure” scene sounds reckless. But we must define our terms.
Warm Zone does not mean unprotected. It means no active threat, controlled access, and limited but present tactical risk. MRTs operate with:
Corridor security provided by law enforcement
Real-time threat updates via shared comms
Protective posture and rapid egress plans
Tactical overwatch where available
Compare that risk to the consequence of inaction: patients dying unattended while medics wait behind fire lines. In today’s threat environment, risk can no longer be eliminated—it must be managed. MRTs in Warm Zones save lives precisely because they accept calculated risk.
The Delays That Kill
Every minute of delay in medical response adds to the body count. These delays come in many forms:
Command Hesitation: Confusion or uncertainty about when to deploy medical.
Policy Restrictions: SOPs that prohibit EMS movement until a “scene safe” call.
Training Gaps: Providers unprepared for austere or dynamic care environments.
Cultural Divides: Fire and EMS unsure of how to communicate with or follow LE entry teams.
Poor Staging Decisions: Medical units placed too far from the scene for timely movement.
Each of these is solvable. But solving them requires leadership, training, and a shift in doctrine. The question isn’t whether MRTs are useful. It’s whether we’re willing to change fast enough to use them.
A Paradigm Shift: From Scene Secure to Scene Survivable
The new doctrine must reflect this truth:
Our job is not to wait for a perfectly secure scene. Our job is to create a survivable scene.
This mindset shift involves:
Moving MRTs to the tactical perimeter, not external staging
Defining tactical-medical integration protocols in SOPs
Training together—not just responding together
Empowering unified command to make real-time medical deployment decisions
Giving MRTs authority and expectation to act early
It’s not about being reckless. It’s about recognizing that perfect safety comes too late to matter.
Unified Tactical-Medical Response: What It Looks Like
In an optimized response model:
Law enforcement moves to contact.
ICP establishes at the TCP, where EMS, fire, and law command co-locate.
MRTs stage forward with gear and comms.
As corridors are cleared, MRTs deploy immediately into Warm Zones.
CCPs are established near victims.
Victims receive early hemorrhage control, airway management, and triage.
Fire and EMS coordinate transport as law enforcement secures extraction routes.
Emergency Management handles community messaging, resource tracking, and support.
This is what a unified tactical-medical response looks like. It's not theory—it's a system already used by forward-leaning agencies. The only barrier to adoption is institutional will.
Training Together: Making the Model Work
The best MRT plan is worthless if not trained. To make early deployment a reality:
Conduct multi-agency full-scale exercises using the CSR (Chaos, Stabilization, Recovery) framework
Rehearse MRT movement under force protection
Build and test CCP setup under pressure
Teach law enforcement how to support medics in Warm Zones
Include Emergency Management in early command discussions, not just recovery
Interoperability doesn’t happen in the moment—it’s built in the months before. You don’t rise to the occasion. You fall to the level of your training.
Conclusion: Change or Continue to Lose
We can’t control when or where the next active shooter event will happen. But we can control how we respond.
If we continue to rely on 1990s-era protocols and 2010s-era command structures, we will lose 2025’s victims to avoidable causes. We don’t need more time—we need more courage to act on what we already know.
The Golden Five Minutes matter more than the Golden Hour.
MRTs must be deployed early to save lives.
Hot and Warm Zone operations are manageable and effective.
Unified tactical-medical responses are not optional, they’re required.
We can adapt together, or fail divided. But know this: waiting to act has never saved a single life.
It’s time to move. It’s time to train. It’s time to unify.
